Filling the Rx: An Analysis of the Perceptions and Attitudes of Medicare Rx Discount Card Holders December 2004 Filling the Rx: An Analysis of the Perceptions and Attitudes of Medicare Rx Discount Card Holders Data Collected by NFO Report Prepared by Jeffrey Love, Ph.D. Copyright © 2004 AARP Knowledge Management 601 E Street NW Washington, DC 20049 http://research.aarp.org Reprinting with Permission AARP is a nonprofit, nonpartisan membership organization dedicated to making life better for people 50 and over. We provide information and resources; engage in legislative, regulatory and legal advocacy; assist members in serving their communities; and offer a wide range of unique benefits, special products, and services for our members. These include AARP The Magazine, published bimonthly; AARP Bulletin, our monthly newspaper; AARP Segunda Juventud, our quarterly newspaper in Spanish; NRTA Live & Learn, our quarterly newsletter for 50+ educators; and our Web site, www.aarp.org We have staffed offices in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. Background Part of AARP’s role of watchdog is monitoring the successes and challenges of the new Medicare Rx discount card. In April of 2004, AARP initiated a series of three surveys among people aged 65 and over eligible for the Medicare Rx discount card. Results from the first survey were reported in the AARP Watchdog report last Summer. This report examines data from the second survey, and notes differences between individuals who signed up for the Medicare Rx discount card and those who did not. A third and final survey of Medicare Rx discount cardholders is planned for February 2005. This final survey will provide an overall assessment of cardholders’ experiences and investigate the Medicare-eligible population’s interest in the new Part D prescription drug plan under Medicare. Among the sample of older persons surveyed, 14% have either secured a Medicare Rx discount card, or applied but not yet received their card. Among this group of cardholders, economic need is clearly the driving force behind their decision to enroll in the program. Clearly, low-income individuals (or those that fit a low income profile – widowed women) are the most likely to have enrolled, recall receiving information about the program, and exhibit information–seeking behaviors related to making a choice among cards. Despite, media reports of confusing or incorrect information, difficulties in applying, and dissatisfaction with the discounts available, those who enrolled in a card program seem to have saved money, did not regard the application process as confusing, and do not want to switch cards when given the opportunity. Survey Sample This report presents an analysis of the behavior and attitudes of 4,001 people aged 65 and over, 510 of which have signed up for and received the Rx discount card, and 64 who have signed up for an Rx discount card but have not received it. The survey was conducted by mail in October 2004, among a panel of Medicare eligible persons aged 65 and over. The sample for this survey reflects the general 65+ population. Specifically, it is largely female (70%), moderate income (half have annual household incomes of less than $17,000), equally likely to be widowed (41%) or married (41%) and Caucasian (91%). Sixty percent of the sample are AARP members. While our respondents’ annual household income is modest, 77% do own their own homes. 1 Experiences in Getting an Rx Discount Card Results of questions that Figure 1: Reasons For Selecting a Medicare Rx assess respondents’ Discount Card (n=574) experiences in getting a card suggest that those who signed up did not primarily use CMS resources to compare and shop for the Card From a 33% Trusted Source best card. Rather, they seem to have responded to a solicitation from a pharmacy or insurance company, filled out the Pharmacist requested paperwork, and Recommended 11% received their cards. This Card means that these individuals were less likely to have experienced the widely reported problems with the Doctor CMS web site and 800 Recommended 3% number, and had a generally Card positive experience in securing a card. Specifically, the majority Card Offers the (64%) of the 574 people who 20% Best Discounts have signed up for the Medicare Rx discount card signed up themselves and were not automatically enrolled. Seventy-seven Card Accepted percent of those who signed at More than 19% One Pharmacy up themselves did so by filling out a paper application and mailing it. Only 3% used the Internet or visited a Social Security office to My Pharmacy 30% apply for a card. Accepts it Sixty-three percent considered it very or somewhat easy to choose 0% 10% 20% 30% 40% 50% among the Medicare approved discount cards offered. Almost 7 in 10 paid 2 nothing to get a card, and Figure 2: Expected Savings with the Medicare Rx almost no one (1%) paid Discount Card (n= 574) over $30 for their card. Sixty-two percent consider the Medicare Rx discount cards to be worthwhile because they either give Not Sure 21% people on Medicare immediate help or provide another way to cut prescription drug costs. Convenience, level of discounts, and trust in the Nothing at All 6% source of the cards were clearly reasons for choosing one card over others. While recommendations from specific doctors or pharmacists did not seem to be that compelling, whether or not respondents’ Not Much 16% pharmacies accept the card was important to decisions about the cards. Experiences in Using the Rx Discount Card Some 31% Almost 6 in 10 Rx discount card holders expect to save a lot (27%) or some (31%) money on their prescription drug costs. Only 22% of cardholders do not expect to save much money with their A Lot 27% cards, and 21% are not sure how much they will save, suggesting that for these people, it may be too early to tell how their Rx discount 0% 10% 20% 30% 40% 50% card will work out. Among those who already have saved money with their 3 Rx discount cards, the Figure 3: Reasons for Not Enrolling (n=3,427) average amount saved thus far is $154. Although older persons eligible for the Medicare Rx Discounts are Too Small 21% discount card soon will be offered the opportunity to switch cards, only 7% say they are likely to do so. Forty-two percent say they will not switch cards while Rx Card is 51% do not know what they Too Confusing 13% will do when the opportunity to switch arises. Non-Cardholders Rx Card is Those respondents who Too 11% decided to not sign up for a Complicated Medicare Rx discount card, declined the card because they already have prescription drug coverage (51%), or already have a Did Not Know About Cards 6% non-Medicare Rx discount card (28%) (Figure 3). Other reasons for not enrolling in the Medicare Rx discount card program Have Rx concerned difficulties with Coverage 51% the enrollment process (24%), doubts about the discounts available (21%), or lack of awareness of the cards (6%). Already Have a Discount 28% As illustrated by Figure 4, Card non-cardholders are more likely to be married and have higher household incomes. 0% 20% 40% 60% Conversely, cardholder demographics fit the low- income profile of the older population – widowed 4 females. There are no age Figure 4: Cardholder and Non-cardholder Selected or race/ethnicity differences Demographics (n = 4,001) between cardholders and non-cardholders. Only 7% of those who did not sign up for a Medicare 68% Rx discount card intend to do so this year or next year. Female Over half (54%) will not sign 80% up, but 39% are unsure. Among those who will not sign up for a card, half (50%) cited a lack of need due to existing coverage, 44% 13% cited doubts about HH < $17K discounts with the card or cost of getting a card, and 73% 5% cited difficulties of selecting a card. Thirty-two percent could not say why they would not sign up for a card. 40% Widowed 52% 43% Married 30% 0% 20% 40% 60% 80% 100% Non-Cardholders Cardholders 5 Differences Between Cardholders and Non-Cardholders Thirty percent of those who Figure 5: Selected Rx Card Information Sources did not enroll in the (n=4,001) discount card program actively investigated the cards and still declined to enroll. Sixty percent were 14% aware of the program but Medicare 800 did not actively investigate Number 27% the discount cards. The fact that most non- cardholders did not actively 8% investigate the discount Medicare program points to a major Website 10% difference between cardholders and those who declined to participate. Those who enrolled in the 22% discount card program Senior Group were much more aware of 12% the specifics of the program than those who did not enroll. Cardholders were much more likely than 33% non-cardholders to have Pharmacist received information about 40% the cards, to have spoken with health care professionals, health insurance or 10% pharmaceutical companies, Doctor or Medicare, than those 9% who did not enroll in the program. Forty-six percent of 47% cardholders spoke with Friends/Family another person in making 28% their decision about the card compared to 21% of non-cardholders. 0% 10% 20% 30% 40% 50% Cardholders were more Non-Cardholders likely than non-cardholders Cardholders 6 to have spoken with health Figure 6: Rx Card Information Behaviors (n=4,001) care professionals, or used resources from Medicare in making their decision, while non-cardholders were more likely to have 21% consulted friends or a Sought senior or community Advice About organization. Cards 46% Specifically, 70% of cardholders received information in the mail about the discount cards compared to 49% of non- cardholders. 45% Feel Rx Cards Helpful Seventy-nine percent of 63% cardholders were aware of the $600 transitional benefit for low income individuals, while 58% of non-cardholders knew about this benefit. 58% Sixty-three percent of Aware of $600 cardholders feel the Benefit 79% discount cards will be very or somewhat helpful to people on Medicare, while 45% of non-cardholders feel this way. 49% Received Mail About Cards 70% 0% 20% 40% 60% 80% Non-Cardholders Cardholders 7 Conclusions Given the complexity and confusion reported in the press about the Medicare Rx discount card program, the positive impression of cardholders in our survey is surprising. It does seem, though, that the majority of cardholders in this survey probably secured their cards by submitting paperwork provided by a pharmacy or card sponsor, instead of using the CMS website and 800 number. Responding to a solicitation by a pharmacy or pharmaceutical company could mean that many cardholders could not compare cards and, perhaps, get the card best suited for their needs. However, these individuals did get a card, seem to have saved money with it, did not regard the process as confusing, and do not want to switch cards when given the opportunity. The difference in information used by cardholders and non-cardholders in making the decision to enroll is striking. Non-cardholders were less likely to have received information about cards, and were less likely to seek help in making their decision. When they sought help, they looked to sources very different (and perhaps less authoritative) than those used by cardholders. Perhaps the bottom line to the data from this second wave of our survey is that the Medicare Rx discount cards have value for many. The challenge for anyone interested in boosting enrollments is to provide simple clear information and options, and make accessing those options as direct as possible. Too many choices may prevent a decision. For this program, a decision to enroll in any card is better than not receiving discounts at all. 8 Methodology This survey was conducted in October, 2004 by mail among a National Family Opinion (NFO) panel of persons aged 65 and older. 4,001 questionnaires were returned, for a return rate of 87%. This panel was constructed to be representative of the 65+ population. The annotated questionnaire appears in Appendix A. For more information about this study, contact Jeffrey Love, Ph.D., Director, AARP Strategic Issues Research, (202) 434-6279. 9 Appendix A: Annotated Questionnaire 1. Medicare-approved drug discount cards began offering discounts to people on Medicare on June 1st of this year. Do you currently have a Medicare-approved drug discount card? (X ONE Box) 13 Yes → (Continue) 86 No → (Skip To Qu. 21) 2 Signed up for card, but haven't received it yet → (Skip To Qu. 3) - Don't know → (Stop And Return Questionnaire) 2. How many weeks have you had the Medicare-approved drug discount card? (Write In) # of Weeks: _____ Median = 8 Mean = 11.4 3. Below are several statements about the new Medicare-approved drug discount cards. Please indicate which one comes closer to your view. (X ALL That Apply) 39 The new cards are WORTHWHILE because they give people on Medicare immediate help before the full prescription drug benefit is available in 2006 45 The new cards are WORTHWHILE because they provide another way to cut prescription drug costs 17 The new cards AREN'T WORTH THE TROUBLE because they don't do enough to help people with their drug costs 5 The new cards AREN'T WORTH THE TROUBLE because they are too confusing to use 20 Don't know 4a. Did you sign up for your Medicare-approved drug discount card yourself, or were you automatically enrolled through another plan? (X ONE Box) 65 Signed up yourself → (Continue) 30 Automatically enrolled → (Skip to Qu. 5) 5 Don't know → (Skip to Qu. 5) 4b. How did you sign up for the Medicare-approved drug discount card? (X ONE Box) 1 On the Internet 2 At a Social Security office 77 Filled out the paperwork and mailed the application 19 Other 5. Do you know anyone else who currently has a Medicare-approved drug discount card? (X ONE Box) 32 Yes 45 No 20 Don't know 10 6. As far as you know, does your card say "Medicare-approved" on it? (X ONE Box) 58 Yes, says Medicare approved 11 No, does not say Medicare approved 25 Don't know 7. Which of the following best describes about how much you paid for your Medicare approved drug discount card? (X ONE Box) 69 Free 3 $10 8 $20 5 $30 1 More than $30 14 Don't know 8. Can your Medicare-approved drug discount card be used at any pharmacy, or only at certain pharmacies? (X ONE Box) 40 Any pharmacy 33 Only certain pharmacies 28 Don't know 9. Was it easy or difficult for you to choose among the different Medicare-approved drug discount cards offered? (X ONE Box) 41 Very easy 22 Somewhat easy 13 Somewhat difficult 9 Very difficult 15 Don’t know 10. Why did you select your particular card? (X ALL That Apply) 30 It’s the card my pharmacy accepts 19 It is accepted at more than one pharmacy 20 It offered the best discounts for the drugs I take 3 It was the card my doctor recommended 11 It was the card my pharmacist recommended 33 It's from a trusted source 11. Before you chose your card, did you receive any information in the mail about the new Medicare-Approved Drug Discount Card program? (X ONE Box) 70 Yes → (Continue) 20 No → (Skip to Qu. 13) 10 Don t know → (Skip to Qu. 13) 11 12. Did this information you received in the mail come from the government, from one of the private companies selling the discount cards, or from some other source? (X ALL That Apply) 59 Government 41 Private company - Some other source (Specify): ______________________________________ 13. Did you talk to anyone or look for information to help you decide whether to sign up for a Medicare-approved drug discount card? (X ONE Box) 46 Yes → (Continue) 48 No → (Skip to Qu. 15) 6 Don t know → (Skip to Qu. 15) 14. Please indicate if you turned to any of the following sources for help in deciding whether to sign up for a Medicare-approved drug discount card. (X ALL That Apply) 28 Friends or family members 9 Your doctor 40 Your pharmacist 12 A seniors' group or community organization - An employer or union 18 A health insurance company 11 A pharmaceutical company 10 The Medicare website 27 The Medicare 800 phone number 15. How much money do you expect to save using your Medicare-approved drug discount card? (X ONE Box) 27 A lot 31 Some 16 Not much 6 Nothing at all 21 Don't know 16. Since you've had the card, if you were to put a dollar amount on what you have saved with your Medicare-approved drug discount card so far, what would be that amount? (Write In) $__________ (Round to the nearest dollar) Mean = $154 12 17. Do you know that some low-income people are eligible for $600 in additional financial help from the government to pay for prescription drug costs? (X ONE Box) 79 Yes 14 No 7 Don't know 18. When you signed up for your Medicare-approved drug discount card, did you also apply for the $600 in low-income assistance? (X ONE Box) 45 Yes 43 No 12 Don't know 19. How helpful do you think the Medicare-approved drug discount cards will be for people on Medicare in general? (X ONE Box) 34 Very helpful 29 Somewhat helpful 18 Not too helpful 6 Not at all helpful 13 Don't know 20a. Do you plan to switch cards when it's time to re-enroll? (X ONE Box) 7 Yes → (Continue) 42 No → (Skip to Qu. 30) 51 Don t know → (Skip to Qu. 30) 20b. If yes, why? (Specify): _________________________________________________________ If you have signed up for or currently have the Medicare-approved drug discount card, please do not answer Qu. 21- Qu. 29 and skip to Qu. 30. 59257 21. What are the reasons why you did not sign up for the Medicare-approved drug discount card? (X ALL That Apply) 28 I already have a card that gives me good discounts 51 I have prescription drug coverage 6 I didn't know about the Medicare-approved drug discount card 11 The card is too complicated 13 The card is too confusing 21 The discounts are too small 13 22a. Do you plan to sign up for a Medicare-approved drug discount card this year or next year? (X ONE Box) 4 Yes, this year 3 Yes, next year 54 Do not plan to sign up for the card 39 Don't know 22b. If you do not plan to sign up for the card, why is that? (Please Be As Specific As Possible) ___________________________________________________________________ 23. Did you investigate getting a Medicare-approved drug discount card this year and decide not to apply? (X ONE Box) 30 Yes 60 No 10 Don't know 24. Have you received any information in the mail about the new Medicare-approved Drug Discount Card program? (X ONE Box) 49 Yes → (Continue) 35 No → (Skip to Qu. 26) 17 Don t know → (Skip to Qu. 26) 25. Did this information you received in the mail come from the government, from one of the private companies selling the discount cards, or from some other source? (X ALL That Apply) 64 Government 47 Private company - Some other source (Specify): ______________________________________ 26. Have you talked to anyone or looked for any information to help you decide whether to sign up for a Medicare-approved drug discount card? (X ONE Box) 21 Yes → (Continue) 73 No → (Skip to Qu. 28) 6 Don t know → (Skip to Qu. 28) 14 27. Please indicate if you have turned to any of the following sources for help in deciding whether to sign up for a Medicare-approved drug discount card. (X ALL That Apply) 47 Friends or family members 10 Your doctor 33 Your pharmacist 22 A seniors' group or community organization 2 An employer or union 12 A health insurance company 5 A pharmaceutical company 8 The Medicare website 14 The Medicare 800 phone number 28. Do you know that some low-income people are eligible for $600 in additional financial help from the government to pay for prescription drug costs? (X ONE Box) 58 Yes 29 No 14 Don't know 29. How helpful do you think the Medicare-approved drug discount cards will be for people on Medicare in general? (X ONE Box) 11 Very helpful 26 Somewhat helpful 28 Not too helpful 10 Not at all helpful 25 Don't know 30. Are you and/or your spouse a member of AARP? (X ONE Box) 60 Yes 38 No 3 Don't know/Not applicable The following questions are used for demographic classification purposes only. 31. What is your current marital status? (X ONE Box) 5 Never married → (Continue) 41 Married → (Skip to Qu. 33) 1 Separated → (Continue) 12 Divorced → (Continue) 41 Widowed → (Continue) 59257 32. Please indicate your personal individual income level. (X ONE Box) 32 Under $10,000 29 $10,000 - $12,999 22 $13,000 - $17,999 10 $18,000 - $24,999 6 $25,000 - $49,999 2 $50,000 + 15 33. Please indicate the combined annual household income level for those married household members age 65 years or older. (X ONE Box) 16 Under $10,000 23 $10,000 - $14,999 9 $15,000 - $16,999 19 $17,000 - $24,999 20 $25,000 - $49,999 8 $50,000 - $74,999 6 $75,000+ - Not applicable / Not married 34. How many people over the age of 65 years live in your household? (Write In) # of people: _____ Median = 1 Mean = 1.4 35. Please indicate your age and sex. Age:______ Sex: 30 Male 70 Female Median = 75 Mean = 75.6 Thank you for your help with this study. Please return your completed questionnaire in the enclosed postage-paid envelope as soon as possible. 16